Aetna Denies Successful Botox Treatment for Migraines
Does it makeany sense to discontinue a treatment that has reduced the frequency of a patient's migraines by 66%? Did you say, "No?" If so, you and I agree. Oddly enough, Aetna, my insurance company doesn't see it that way.
Let me pause here and set the stage for you...
时间：2012年11月。
我有25天的偏头痛和头痛，其中23天偏头痛。
The problem:
My work was suffering.
My family life was suffering.
was suffering!
My migraine specialist, Dr. David Watson suggested that we try Botox, for a few reasons:
Due to issues that hospitalized me a couple of years ago, we can't add any medication that might lower my blood pressure or increase the dosage of the medications I was already taking that lower my blood pressure.
I had terrible side effects from topiramate (Topamax), and zonisamide (Zonegran), another medication in the same family, had failed to help.
Botox had been working well for some of his other chronic migraine patients.
2012年12月：
沃森博士管理首次肉毒杆菌治疗，并将偏头痛减少约50％。
2013年3月：
Dr. Watson administers second Botox treatment, and the reduction in my migraines increases to 66%.
向前迈进，2013年12月：
My number of migraine days remains around eight per month, a 66% decrease from November of 2012. That's still too many migraines, so Dr. Watson and I are considering possibilities to improve the effectiveness of my preventive regimen.
但一封信来自我的Aetna，保险公司2013年12月11日的保险公司。它说他们不在2013年10月，肉毒杆菌治疗支付。
What?!
首先，Botox治疗必须提前被保险公司批准，他们确实批准了它。其次，他们在想什么？Botox一直在工作。它让我回到了工作和享有一些生活。它不仅降低了偏头痛的数量，而且还减少了严重程度。它还减少了我的嵌入噬菌体（增加了对偏头痛攻击之间的光的敏感性）。
Here's part of the letter I received from Aetna:
“Aetna认为在以下条件下是必要的Inabotulinumtoxina（Botox）：偏头痛 - 用于预防慢性（每月超过14天，每天持续4小时或更长的头痛）偏头痛，在至少审判和失败的成年人中，他们至少尝试过的成年人3阶段偏头痛头痛预防药物至少为每种药物的至少2个月（60天）。肉毒杆菌毒素被认为是不符合上述标准的偏头痛的实验性和研究。“
换句话说，Botox已经努力工作，即我不再符合慢性偏头痛的标准，因此他们认为它是“实验和调查”，因为它仅被FDA批准了慢性偏头痛，而且他们不会支付为了它。对他们来说，Botox是我偏头痛目前慢性的唯一原因。没有。根本没关系。他们拥有Watson博士在我的第一轮Botox之前提交的信息，因此他们不能声称不能看到Botox对我所做的。虽然它不是我能证明的东西，但我怀疑它纯粹而简单地归结为美元。对于我的Botox治疗，他们每三个月支付大约1,700美元。
Here are some of my important points and issues:
由于它花了这么长时间才否认这一索赔，因此在我的下一轮Botox之前几乎没有机会通过他们的上一轮肉毒杆菌毒素，该机会预定于2014年1月15日。
很明显，如果我们停止有效的预防性治疗，那么回到它，它可能无法工作。因此，如果由于Aetna的短视政策，我必须停止肉毒杆菌毒素，它可能无法再次起作用。
他们也一直在弄乱我的曲坦偏头痛的堕胎，并且用肉毒杆菌毒素，我终于达到了我足以完成一个月的地步。
Axert曲普坦是最适合我的,但一个etna no longer covers it. It really doesn't matter to me which triptan I use as long as it works. Axert almost always works for me with one dose. With Botox reducing my number of migraines to an average of eight a month, I would have been at the point of having enough Axert to be able to treat all of them. (And no, I wouldn't have had the risk of medication overuse headache because I'm having only an average of two migraine days per week.) BUT, since they won't pay for Axert, I'm using zolmitriptan (Zomig), and with it, I often have to use two doses to treat one migraine. Since they alsolimit the number of doses per month对于七，如果每偏头痛服用两剂，那么每月只能给予我足够的治疗3.5偏头痛。
"Experimental and investigational?" Uh huh. Right. I still contend that it comes down to dollars because they've had no issue covering other medications for me that aren't FDA approved for any migraine - chronic or episodic.
我的丈夫和我为我的健康保险支付保费。我们不能支付为我偏头痛工作的治疗费用，以支付保险。
So, what's next?
我在我的个人博客上博彩了，Putting Our Heads Together, on December 21。当我发推文博客文章时，我肯定会在Twitter上标记@aetna。我的推文后六分钟，@aetnahelp推文跟随他们，所以他们可以发给我一个直接留言。我做了，他们发了一个直接留言：
"We appreciate you following us! Please send your Name, DOB, Aetna ID, Twitter name & details to xxx. ^CD"
I sent them the requested information on December 22, but have yet to hear back from them.
由于没有时间等待他们的回复，我开始了上诉过程。如果上诉过程无法完成，我不知道该怎么办涉及上诉过程。延迟肉毒杆菌治疗将导致偏头痛增加。我们从调度中知道我的偏头痛通常在治疗前的过去两周内开始增加。如果我无法按时获得下一次治疗，我真的不想看到他们会得到多么糟糕。
If I lose the appeal, the next step will be to hire an attorney and sue Aetna. Notice that I saidwillbe, not would be or could be. There isn't a choice here. I simply can't go back to nearly daily migraines, especially when I know how much Botox helps me. If I'm forced to sue, I will hire the best attorney I can find, and I'll tell him or her to go after everything they can get. This goes beyond not paying the $1,700 for the Botox. Aetna is costing time and considerable emotional distress. They're causing me to live in fear of losing the treatment that's working to keep my migraines episodic instead of them being chronic, like they were just over a year ago. No, I don't want to have to sue Aetna, but if they force me to do so, I'll go all the way.
在这次艰难的时刻，请让我在思想中。当事件展开时，我会发布更新，让您知道事情是如何以及发生的事情。
